The Environment, a Changing Climate, and Planetary Health

This chapter addresses the dynamic balance between human health and the environment, with a focus on the global health and human rights threat of climate change. International legal efforts to mitigate environmental damage and climate change—from the 1992 United Nations Framework Convention on Climate Change and its 1997 Kyoto Protocol to the 2015 Paris Agreement—have been limited in addressing the threats posed to global health. Human rights will be necessary to examine efforts to mitigate and respond to these cataclysmic threats, including rising temperatures and extreme weather events, air pollution, infectious diseases, food, water and sanitation, and mental health. Facing this unprecedented threat, advocates can draw from past advances, including the use of litigation to protect human rights affected by the environment, the realization of the right to enjoy the benefits of scientific progress, and the implementation of human rights as a foundation of planetary health.

Chronic Illness

This chapter sets out the connection between disability and human rights, examining how persons with disabilities (including those with physical disabilities, sensory disabilities, psychosocial or mental health disabilities, and intellectual disabilities) are particularly vulnerable to exclusion and discrimination, leading to human rights violations across the world. It has been a long global struggle to recognize the rights of people with disabilities and realize the highest attainable standard of physical, mental, and social well-being, a struggle evolving across countries and culminating in the 2006 adoption of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The provisions of the CRPD relate to three specific rights that are of particular importance to people with disabilities: legal capacity, the right to health, and the right to independent living. Yet, national implementation challenges remain, including finding space for mental health and disability in policymaking and developing models of service delivery that advance human rights.

Communicable Diseases, Health Security, and Human Rights

This chapter examines the influence of human rights in the quest to control communicable diseases. Communicable diseases are emerging and spreading faster than ever before, with devastating consequences for the most vulnerable in a rapidly globalizing world. Human rights have come to frame infectious disease control, beginning in the early response to AIDS and expanding from the stigmatization of marginalized populations to include the provision of essential medicines. Human rights claims have correspondingly expanded, arising out of norms of non-discrimination, consent, and privacy and now including the right to health. As individual rights compete with state authority, the World Health Organization’s (WHO’s) International Health Regulations (2005) aim to guide states in a rights-based response to communicable disease. However, as seen in recent Ebola outbreaks, human rights have lost priority to health security as the dominant frame for health policy, and this securitization of communicable disease control may undermine the gains of human rights, risking the future of global health.

Human Rights Advocacy in Global Health

This chapter presents an overview of health and human rights advocacy and describes a broad framework and the diverse strategies used by human rights advocates to advance their goals. Based upon documenting abuses, raising awareness, building coalitions, and engaging communities, human rights advocacy seeks to ensure that government laws, policies, and practices respect, protect, and fulfill the right to health of all. These rights arguments and advocacy strategies, first developed in response to the HIV epidemic, have become the basis for broader right to health campaigns. Health-related human rights advocacy, beyond specific strategies, seeks to elevate the voices of people affected by human rights violations, analyze structural barriers, and identify obligations and responsibilities. Focusing on the strategies and tools that human rights advocates use in documenting rights abuses, raising awareness, and seeking change, it is necessary to examine new advocacy partnerships and approaches for evaluating advocacy efforts.

Translating International Law into Domestic Law, Policy, and Practice

This chapter provides an overview of the means through which international human rights law is translated into domestic law, policy, and practice. To have an influence on public health, international human rights law must be translated into domestic action. As international human rights law is largely state centered, it relies upon national and subnational governments to implement it—to promote and protect human rights and to provide remedies to victims of human rights violations. Based upon international rules on domestic implementation, there are four general approaches to translate international law into domestic action: human rights education, policymaking, judicial actions, and engagement with international human rights mechanisms. National and subnational governments use these four approaches to translate international human rights law into domestic law, policy, and practice for health, while nongovernmental organizations and international human rights mechanisms play important roles in monitoring these processes.

The Right to Health and Health-Related Human Rights

This chapter reviews the scope and meaning of the right to health under international law. Drawing on public health discourses and expanding beyond a right to health care, the contours of the right to health have been clarified—to encompass a wide range of social, political, and economic determinants of health—by the United Nations Committee on Economic, Social and Cultural Rights (CESCR) in its General Comment 14, by academics in the fields of law and public health, and by national governments in their domestic laws and judicial interpretations. The normative content of the right to health now provides a foundation for state obligations to respect, protect, and fulfill the right to health; limitations on other rights for public health goals; the right’s essential attributes of availability, accessibility, acceptability, and quality; the minimum core obligations of the right to health; and the progressive realization of health-related human rights.

Human Subjects in Globalized Health Research

The clinical trials enterprise has expanded globally, involving research developed and owned by research institutions in wealthy countries but conducted with participants in low- and middle-income countries (LMICs). These LMICs commonly provide ready access to large pools of subjects who have never received a particular drug and have—at least historically—a more permissive regulatory environment, raising important questions about the rights of vulnerable participants. The unequal power dynamic and imbalances between researchers and human subjects require specific norms and procedures to respect and protect the human rights of trial participants. Complementing bioethics norms, human rights law offers a lens for understanding participant and public health interests, recognizing the unequal dynamic between the researcher and the individual subject, and furthering the participants’ autonomy and decision-making power. Framing these issues in human rights obligations additionally offers new forms of governance and accountability mechanisms, raising new opportunities for legally enforceable claims.

Health and Human Rights in Conflict and Emergencies

This chapter explores the relationship between international humanitarian law and human rights law in safeguarding health and protecting rights in conflict and emergencies, examining the evolving role of aid workers as protectors of health-related rights. Complex Humanitarian Emergencies (CHEs)—from mass displacements, to disease outbreaks, to violent conflicts—create an environment for human rights violations and a challenge for human rights promotion. Humanitarian aid, operating within an interconnecting framework across two bodies of law, has the distinctive ability to mitigate violations, prevent harm, and realize rights. Yet the breakdown in social norms and government systems in conflicts and emergencies creates chaos that requires humanitarian responders to engage in lifesaving service provision and community resiliency support. This role, carrying both power and privilege, requires systems of accountability to ensure health and human rights.

The Birth and Development of Human Rights for Health

This chapter examines the historical origins of human rights as a basis for public health. Tracing the idea of rights from philosophical notions of natural rights to human rights under international law, the normative foundations underlying rights have long been seen as central to health and well-being—from the political engagement with underlying determinants of health in 1848 to the international codification of the Universal Declaration of Human Rights (UDHR) in 1948. The modern human rights system that frames public health arose in response to the deprivations and atrocities of World War II. Giving rise to the notion of human rights under international law, the postwar creation of the United Nations (UN) provided the structure for a new legal regime under which individuals were seen as having certain rights by virtue of their humanity, ensuring a foundation for the evolution of rights to advance health.

Global Health Law

This chapter provides an understanding of the legal foundations of human rights, examining human rights under international law as a basis for social justice in public health. International human rights law has codified the rights first enumerated in the Universal Declaration of Human Rights (UDHR), evolving through the politics of the Cold War to develop the International Covenant on Economic, Social and Cultural Rights (ICESCR). This seminal covenant and the international treaties that derived from it have framed the legal foundations of the human right to health and the evolution of health-related human rights. Yet, where challenges remain in responding to the health needs of a globalizing world, scholars and advocates have looked to a shift from international health law to global health law, facilitating collaboration between state and nonstate actors in an expanding global health policy landscape.